U.S. patent number 10,945,800 [Application Number 15/439,915] was granted by the patent office on 2021-03-16 for patient-side mechanized surgical system.
This patent grant is currently assigned to GREAT BELIEF INTERNATIONAL LIMITED. The grantee listed for this patent is GREAT BELIEF INTERNATIONAL LIMITED. Invention is credited to Nicholas J Bender, James Cuevas, Nicholas J. Jardine, Keith Philip Laby, Richard M Mueller, Mohan Nathan, Matthew R Penny, Galen Robertson, Carson Shellenberger, Lucas A. Tew, Jeff Wilson.
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United States Patent |
10,945,800 |
Penny , et al. |
March 16, 2021 |
Patient-side mechanized surgical system
Abstract
A motorized surgical system includes at least one support
positionable within a sterile field in proximity to a patient
positioned on a surgical table. An instrument driver is carried by
the support and includes a steerable distal end positionable in a
body cavity. A user input device is carried by the support and is
configured to generate movement signals in response to manual
manipulation of a portion of the user input device by a user. One
or more steering motors are operably coupled to the instrument
driver and are operable to deflect the steerable distal end of the
instrument driver in response to the movement signals.
Inventors: |
Penny; Matthew R (Holly
Springs, NC), Bender; Nicholas J (Raleigh, NC), Nathan;
Mohan (Raleigh, NC), Jardine; Nicholas J. (Cary, NC),
Robertson; Galen (Apex, NC), Shellenberger; Carson
(Raleigh, NC), Tew; Lucas A. (Raleigh, NC), Mueller;
Richard M (Chapel Hill, NC), Cuevas; James (Santa
Barbara, CA), Wilson; Jeff (Goleta, CA), Laby; Keith
Philip (Oakland, CA) |
Applicant: |
Name |
City |
State |
Country |
Type |
GREAT BELIEF INTERNATIONAL LIMITED |
Tortola |
N/A |
VG |
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Assignee: |
GREAT BELIEF INTERNATIONAL
LIMITED (Tortola, VG)
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Family
ID: |
1000005427724 |
Appl.
No.: |
15/439,915 |
Filed: |
February 22, 2017 |
Prior Publication Data
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Document
Identifier |
Publication Date |
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US 20170165019 A1 |
Jun 15, 2017 |
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Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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13939229 |
Jul 11, 2013 |
9603672 |
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13759036 |
May 10, 2016 |
9333040 |
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61594362 |
Feb 2, 2012 |
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61714737 |
Oct 16, 2012 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B
34/37 (20160201); A61B 34/30 (20160201); A61B
34/70 (20160201); A61B 34/71 (20160201); A61B
2017/2906 (20130101); A61B 2017/003 (20130101); A61B
2017/3447 (20130101); A61B 2034/305 (20160201); A61B
2034/301 (20160201); A61B 2017/00477 (20130101) |
Current International
Class: |
A61B
34/00 (20160101); A61B 34/37 (20160101); A61B
17/00 (20060101); A61B 34/30 (20160101); A61B
17/29 (20060101); A61B 17/34 (20060101) |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Shi; Katherine M
Assistant Examiner: Mendoza; Michael G
Parent Case Text
This application is a continuation of U.S. Ser. No. 14/197,157,
filed Mar. 5, 2014, which is a continuation of U.S. Ser. No.
13/759,036, now U.S. Pat. No. 9,603,672 filed Feb. 4, 2013, which
claims priority to U.S. Provisional Application No. 61/594,362,
filed Feb. 2, 2012, and U.S. Provisional Application No.
61/714,737, filed Oct. 16, 2012. Each of the foregoing is
incorporated herein by reference.
Claims
We claim:
1. A motorized surgical system, comprising: at least one support
positionable within a sterile field in proximity to a patient
positioned on a surgical table; an instrument driver carried by the
at least one support, the instrument driver having a steerable
distal end positionable in a body cavity, the instrument driver
comprising a steerable finger having a lumen proportioned to
receive a distal portion of a surgical instrument and at least one
actuation element extends at least partially through the finger; a
user input device carried by the at least one support, the user
input device configured to generate movement signals in response to
manual manipulation of a portion of the user input device by a
user; and at least one steering motor operably coupled to the
instrument driver, the steering motor operable in response to the
movement signals to cause tensioning of the actuation element so as
to deflect the finger; at least one roll driver carried by the
support, the roll driver positioned to rotationally couple with a
shaft of a surgical instrument that is positioned through the
lumen, a roll input device carried by the support, the roll input
device configured to generate roll signals in response to manual
manipulation of the roll input device; and a roll motor, the roll
motor operably coupled to the roll driver, the roll motor operable
to move the roll driver in response to the roll movement signals,
wherein: the system includes a base mountable on the support, the
steering motor is housed within the base and includes a first drive
member exposed on the motor housing, and the roll motor includes a
second drive exposed on the motor housing; the actuation element of
the instrument driver is disposed on at least one pulley, and the
instrument driver includes a first driven member rotatable to
rotate said at least one pulley; the roll driver includes a tubular
member having a lumen proportioned to receive a distal shaft
portion of a surgical instrument, and a second driven member
rotatable to rotate said tubular member; and the instrument driver
and roll driver are removably positionable on the base to
rotationally couple the first drive member with the first driven
member and to rotationally couple the second drive member with the
second driven member.
2. The system of claim 1, wherein: the roll driver includes a roll
driver housing, the tubular member disposed within the roll driver
housing and the second driven member exposed at the exterior of the
roll driver housing; and the instrument driver includes an
instrument driver housing, said at least one pulley disposed within
the instrument driver housing and the first driven member exposed
at the exterior of the instrument driver housing.
3. The system of claim 2, wherein the roll driver housing comprises
the instrument driver housing.
4. The system of claim 2, wherein the roll driver housing and the
instrument driver housing are separate housings.
5. The system of claim 1, wherein the instrument driver and the
user input device are on a common support.
6. The system of claim 5, wherein said at least one support
includes: a first support positionable within a sterile field in
proximity to a patient, the instrument driver carried on said first
support; and a second support positionable within the sterile field
in proximity to the patient, the user input device carried on said
second support.
7. The system of claim 6, wherein the at least one steering motor
is carried on the first support.
8. A motorized surgical system, comprising: at least one support
positionable within a sterile field in proximity to a patient
positioned on a surgical table; an instrument driver carried by the
at least one support, the instrument driver having a steerable
distal end positionable in a body cavity, the instrument driver
comprising a steerable finger having a lumen proportioned to
receive a distal portion of a surgical instrument and at least one
actuation element extends at least partially through the finger,
wherein the instrument driver further includes an instrument driver
housing; at least two actuation elements, a first pulley within the
instrument driver housing and coupled to one of the actuation
elements, the first pulley including a first gear; a second pulley
within the instrument driver housing and coupled to one of the
actuation elements, the second pulley including a second gear; a
third gear engaged with the first and second gears; and a driven
member exposed on the instrument driver housing a user input device
carried by the at least one support, the user input device
configured to generate movement signals in response to manual
manipulation of a portion of the user input device by a user; and
at least one steering motor operably coupled to the instrument
driver, the steering motor comprising a motor housing and includes
a drive member exposed on the motor housing, the steering motor
operable in response to the movement signals to cause tensioning of
the actuation element so as to deflect the finger; at least one
roll driver carried by the support, the roll driver positioned to
rotationally couple with a shaft of a surgical instrument that is
positioned through the lumen, a roll input device carried by the
support, the roll input device configured to generate roll signals
in response to manual manipulation of the roll input device; and a
roll motor, the roll motor operably coupled to the roll driver, the
roll motor operable to move the roll driver in response to the roll
movement signals wherein the motor housing and the instrument
driver housing are positionable to rotationally couple the driven
member and the drive member such that activation of the motor
rotates the third gear and the pulleys.
9. The system of claim 8, further including a sensor positioned to
generate a signal in response to positioning of the instrument
driver housing in contact with the motor housing.
10. The system of claim 8, further including a sensor positioned to
generate a signal in response to engagement of the first and second
engaging members.
11. The system of claim 8, wherein one of the first and second
engaging members is a male member and the other of the first and
second engaging members is a female member.
12. The system of claim 11, wherein at least one of the first and
second engaging members is a depressible member moveable relative
to its corresponding housing between an extended position and a
partially depressed position, and wherein said depressible member
includes a spring positioned such that contacting the first and
second engaging members causes the depressible member to move
against the spring into the depressed position, and to return to
the depressible member to the extended position under action of the
spring to cause the first and second engaging members to mate.
13. The system of claim 12, further including a sensor positioned
to generate a signal in response to movement of the depressible
member from the depressed position to the extended position.
Description
TECHNICAL FIELD OF THE INVENTION
The present invention relates to the field of access devices and
ports through which flexible medical instruments may be introduced
into a body cavity and steered or deflected.
BACKGROUND
In conventional laparoscopic procedures, multiple small incisions
are formed through the skin, underlying muscle and peritoneal
tissue to provide access to the peritoneal cavity for the various
medical instruments and scopes needed to complete the procedure.
The peritoneal cavity is typically inflated using insufflation gas
to expand the cavity, thus improving visualization and working
space. In a typical laparoscopic medical procedure, four ports are
strategically placed around the abdominal area allowing the surgeon
visualization and use of instruments using principles of
triangulation to approach the surgical target. While this procedure
is very effective and has stood as the gold standard for minimally
invasive surgery, it suffers from a number of drawbacks. One such
drawback is the need for multiple incisions to place the four
ports, which increases the risk of complications such as
post-operative herniation and prolonged patient recovery. The four
port method also raises concerns of cosmesis, leaving the patient
with four abdominal scars.
Further developments have led to systems allowing procedures to be
performed using multiple instruments passed through a single
incision or port. In some such single port procedures,
visualization and triangulation are compromised due to linear
instrumentation manipulation, and spatial confinement resulting in
what has been known as "sword fighting" between instruments.
Improvements on the prior single port techniques are found in the
multi-instrument access devices suitable for use in SPS procedures
and other laparoscopic procedures and described in co-pending U.S.
application Ser. No. 11/804,063 ('063 application) filed May 17,
2007 and entitled SYSTEM AND METHOD FOR MULTI-INSTRUMENT SURGICAL
ACCESS USING A SINGLE ACCESS PORT, U.S. application Ser. No.
12/209,408 filed Sep. 12, 2008 and entitled MULTI-INSTRUMENT ACCESS
DEVICES AND SYSTEMS, U.S. application Ser. No. 12/511,043, filed
Jul. 28, 2009, entitled MULTI-INSTRUMENT ACCESS DEVICES AND
SYSTEMS, and U.S. application Ser. No. 12/649,307, filed Dec. 29,
2009, (US Publication 2011/0230723) entitled ACTIVE INSTRUMENT PORT
SYSTEM FOR MINIMALLY-INVASIVE SURGICAL PROCEDURES, each of which is
incorporated herein by reference.
U.S. application Ser. No. 12/649,307 (US Publication 2011/0230723)
filed Dec. 29, 2009 and entitled ACTIVE INSTRUMENT PORT FOR
MINIMALLY-INVASIVE SURGICAL PROCEDURES describes a system for use
in performing multi-tool minimally invasive medical procedures
using a plurality of instruments passed through a single incision
in a body cavity. The disclosed system includes an insertion tube
and a pair of instrument delivery tubes (IDTs) extending from the
distal end of the insertion tube. Each IDT has steerable distal
portion positioned distal to the distal end of the insertion tube.
In use, flexible instruments passed through the IDTs are steered by
actively deflecting the deflectable distal portions of the IDTs. In
particular, proximal actuators (shown as ball-and-socket or gimbal
type actuators) for the IDTs are positioned proximally of the
insertion tube. Instruments to be deployed from the IDTs into the
body cavity are inserted through the proximal actuators into the
IDTs. The proximal actuators are moveable in response to
manipulation of the handles of instruments extending through the
IDTs. Movement of the proximal actuators engages pull elements
(e.g. wires, cables etc) that extend from the proximal actuators to
the deflectable sections of the IDT's, thus steering the distal
portions of the IDTs (and thus the distal ends of the instruments
themselves). Additional instruments such as scopes and other
instruments may also be passed through the insertion tube (such as
through rigid instrument channels) and used simultaneously with the
instruments deployed through the IDTs.
Additional examples of proximal actuators and/or IDT shafts that
may be used in such access systems are described in U.S.
2011/0184231, entitled DEFLECTABLE INSTRUMENT PORTS, U.S.
2011/0060183, entitled MULTI-INSTRUMENT ACCESS DEVICES AND SYSTEMS,
and U.S. 2011/0251599 entitled DEFLECTABLE INSTRUMENT SHAFTS, each
of which is incorporated herein by reference.
The present application describes new multi-instrument surgical
access systems for use in minimally invasive procedures.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1A is a perspective view of a motor-assisted multi-instrument
surgical system. FIGS. 1B through 18 are various views of
components of the first embodiment, in which:
FIG. 1B shows the system supported by an arm and positioned
relative to an operating table.
FIG. 1C is a partially exploded perspective view of the base unit,
roll driver and finger drive assembly.
FIG. 1D is a perspective view of a proximal part of the finger
drive assembly.
FIG. 2A is a perspective view of the distal portion of the
deployment mechanism.
FIG. 2B is a perspective view of the proximal portion of the
deployment mechanism.
FIG. 2C is a plan view of the underside of the proximal portion of
the deployment mechanism.
FIG. 3 is a perspective view of a finger driver, including the
pulley housing.
FIG. 4A is similar to FIG. 3, but without the pulley housing.
FIG. 4B is a bottom perspective view of the components of the
finger driver, without the pulley housing, proximal tube and
cables.
FIG. 5A shows a pulley of a finger driver.
FIGS. 5B and 5C are partially exploded views of the pulley of FIG.
5A.
FIGS. 6A and 6B schematically illustrate operation of the pulleys
of the finger driver.
FIG. 7A is a perspective view showing the underside of the finger
drive assembly.
FIG. 7B is a perspective view showing the top side of the base
unit.
FIG. 8A is a plan view showing the layout of the motors, sensors
and gear assemblies within one half of the base unit.
FIG. 8B is a perspective view of one of the motors and gear
assemblies from FIG. 8A.
FIG. 9 is a perspective view of a roll driver.
FIG. 10 is a perspective view of the roll drive tube and gear
assembly of the roll driver.
FIG. 11A is a side elevation view of an instrument that may be used
with the system.
FIG. 11B is a perspective view of the handle and proximal shaft of
the FIG. 11A instrument.
FIG. 12A is a perspective view of the drive segment of the
instrument of FIG. 11A.
FIG. 12B shows the drive segment of FIG. 12A positioned within the
roll drive tube.
FIGS. 13A and 13B are end views of an alternative roll drive tube
and drive segment, respective.
FIG. 13C shows rotational engagement of the roll drive tube and
drive segment of FIGS. 13A and 13B.
FIG. 14 shows rotational engagement of a second alternative roll
drive tube and drive segment.
FIG. 15 is an exploded view of a tubular connector positionable
between the housing and roll driver of FIG. 1A.
FIG. 16 is a perspective view of the command interface, showing the
instrument box separated from the brackets. The handle of an
instrument, but not its distal shaft, is shown.
FIG. 17A is a proximal perspective view of the instrument box with
the housing removed and with an instrument handle withdrawn from
the operative position. The distal shaft of the instrument is not
shown.
FIG. 17B is a distal perspective view of the instrument box with
the housing removed.
FIG. 18A is a block diagram schematically illustrating components
of a variation of the system;
FIG. 18B schematically illustrates an exemplary algorithm for
controlling movement of the fingers by the system.
FIG. 19 is a perspective view of a second embodiment.
FIG. 20 is a perspective view of a third embodiment.
FIG. 21 is a perspective view of a fourth embodiment.
FIG. 22 is a perspective view of a fifth embodiment.
FIG. 23 is a perspective view of a sixth embodiment.
FIG. 24 is a perspective view of a seventh embodiment.
FIG. 25 is a perspective view of a user interface that may be part
of the sixth and seventh embodiments.
FIG. 26 is a perspective view of an eighth embodiment.
DETAILED DESCRIPTION
The present application discloses a new motor-assisted
multi-instrument surgical system having certain advantages over
prior art systems.
Overview
Referring to FIG. 1, a first embodiment of a surgical access system
2 includes a finger drive assembly 200 comprising a housing 210 and
an insertion cannula 212 extending distally from the housing 210.
Steerable instrument delivery tubes or tubular fingers 214 extend
distally from the insertion cannula 212. The tubular fingers 214
have lumen for receiving passively flexible surgical instruments
100. As will be described below, motor-driven finger drivers within
the finger drive assembly 200 steer the fingers 214 using cables
anchored at the distal ends of the fingers. Associated with each
tubular finger 214 is a corresponding motor driven roll driver
216--which acts on a distal portion of the instrument shaft to
rotate it axially.
In the first embodiment, the motors used to actuate the finger
drivers and the roll drivers, as well as associated controllers and
electronics are housed within a base unit 218, and the finger drive
assembly 200 and the roll drivers 216 are removably mounted to the
base in a manner that delivers motion from the motors to the finger
drivers and roll drivers. Spring latches 255 (FIG. 1A) are
positioned to engage the finger drive assembly 200 and roll drivers
216 with the base 218 when they are placed on the base in the
proper orientation. Alignment features 215 (FIG. 1C) on the upper
surface of the base unit 218 mate with or contact corresponding
features at the lower surface of the finger drive assembly 200 and
roll drivers 216. The alignment features help align the assembled
components and to prevent components mounted to the base 218 from
sliding relative to the surface of the base during use.
The base unit 218 can be a reusable component isolated from the
sterile field using a sterile drape or bag (not shown), whereas the
finger drive assembly 200 and roll drivers 216 may be manufactured
as single-use components or re-usable components for a number of
times prior to disposal. Re-usable components may be designed for
autoclaving or other forms of sterilization.
Command interfaces 250 are provided for each of the tubular fingers
214. The command interfaces 250 include instrument boxes 252 that
support the instrument handles. The command interfaces 250 are user
input devices that generate signals in response to the user's
manipulation of the instrument handle (e.g. pan, tilt and roll)
and/or other user inputs. In response to signals generated at the
command interface 250, the system's motors are controlled to cause
the finger driver and roll driver to drive the fingers and
instrument in accordance with the user input.
Referring to FIG. 1B, the system 2 is supported by a support arm
204 extending from a patient-side cart 205, the operating table
206, a ceiling mount, or another fixture that positions the arm 204
where it can support the finger and roll drivers, the associated
motors, and the command unit near the operating table, allowing the
surgeon to stand patient-side with his/her hands on the instruments
100. The arm may be one allowing repositioning of the system 2 in
multiple degrees of freedom. While a robotically-controlled arm
could be used with the system 2, since control and manipulation of
the instruments is achieved using the system 2 rather than
maneuvering of the arm 204, the arm may be much simpler in design
and smaller in size than those used for conventional robotic
surgery. The illustrated arm 204 is manually positionable about
multiple joints and lockable in a selected position. Multiple
degree of freedom movement allows the user to position the system 2
to place the insertion cannula 212 and the command interfaces 250
in the desired position relative to the patient and the surgeon.
The cart 205 can be used to carry other equipment intended for use
with the system 2, such as components supporting visualization,
insufflations, stapling, electrosurgery, etc. The arm 204 has
internal springs which counterbalance the weight of system 2,
allowing it to remain stable in space while the arm is unlocked,
and reduces the force required to move the system. While many joint
combinations are possible the four bar linkages shown in the
pictured embodiment allow for the system 2, to pivot about the
center of gravity, which reduces the force required to reposition
the system.
The system's power supply, computer and user controls (e.g. touch
screen computer 201), which are discussed with respect to the
system schematic at FIG. 18, may be mounted on the cart 205 with
their associated cabling routed through the arm 204 to the base
unit 218.
A brief overview of the manner in which the system 2 is used will
facilitate an understanding of the more specific description of the
system given below. During use, the fingers 214 and a portion of
the insertion tube 212 are positioned through an incision into a
body cavity. The distal end of a surgical instrument 100 is
manually, removably, inserted through an instrument box 252 of
command interface 250, and the corresponding roll driver 216 and
into the corresponding tubular finger 214 via the finger drive
assembly 200. The instrument is positioned with its distal tip
distal to the distal end of the tubular finger 214, in the
patient's body cavity, and such that the handle 104 of the
instrument is proximal to the command interface 250.
The user manipulates the handle 104 in an instinctive fashion, and
in response the system causes corresponding movement of the
instrument's distal end. The motors associated with the finger
driver are energized in response to signals generated when the user
moves the instrument handles side-to-side and up-down, resulting in
motorized steering of the finger and thus the instrument's tip in
accordance with the user's manipulation of the instrument handle.
Combinations of up-down and side-side motions of an instrument
handle will steer the instrument's tip within the body cavity up to
360 degrees. Manual rolling of the instrument handle about the
instrument's longitudinal axis (and/or manually spinning of a
rotation knob or collar proximal to the instrument handle) results
in motorized rolling of distal part of the instrument's shaft 102
(identified in FIG. 11) using the roll driver 216.
Finger Drive Assembly
Referring to FIGS. 1A, 1C and 1D, the insertion tube 212 of the
finger drive assembly 200 is an elongate tube positionable through
an incision in a body cavity. The system is arranged such that
multiple instruments may be introduced into the body cavity via the
insertion tube. The illustrated embodiment allows for simultaneous
use of three or four instruments--two that are actively steered
using the tubular fingers 214, and one or two that enter the body
via passive ports in the finger drive assembly 200. Different
numbers of active channels (steerable fingers 214) and passive
ports may instead be used in the system without departing from the
scope of the invention. For example, an alternative system might
include a single steerable finger 214 and no passive ports, or the
illustrated system might be modified to add one or more steerable
fingers 214 or to add or eliminate passive ports.
Deployment Mechanism
The finger drive assembly 200 has a deployment mechanism that is
operable to simultaneously or independently reposition the distal
portion of each finger 214 to increase or decrease its lateral
separation from the longitudinal axis of the insertion cannula 212.
The deployment mechanism moves the fingers 214 between an insertion
position in which the fingers are generally parallel to one another
for streamlined insertion, and one or more deployed positions in
which the fingers are pivoted laterally away from the longitudinal
axis of the insertion tube as shown in FIG. 1A. U.S. Publication
Nos. US 2007-0299387 and US 2011-0230723 illustrate deployment
mechanisms that can be used for the system 2.
The first embodiment uses a deployment mechanism shown in FIG. 2A
using pivotable links 12 for this purpose, with each link 12
pivotably coupled between a finger 214 (only a portion of which is
shown in the figure) and one or more elongate members 14, which can
slide relative to (and, in the illustrated embodiment, partially
within) the insertion tube 212. Additional links 16 may extend
between the distal end of the insertion tube 212 and the fingers
214, providing additional support for the fingers. In the drawings,
these additional links 16 have a rectangular cross-section with
their long edges oriented to resist bending when the fingers are
loaded--such as when instruments in the finger are being used to
grasp and elevate tissue. The proximal ends of the links 16 form a
hinge coupled to the insertion tube as shown.
As shown in FIGS. 2B and 2C the proximal ends of the members 14 are
connected to a block 18 moveable relative to the finger drive
assembly's housing 210 between distal and proximal positions to
slide the members 14 between distal and proximal positions. Sliding
the members 14 in this way causes the link arms 12 to pivot and to
thereby move the fingers laterally.
A ratchet feature 224 (FIG. 2B) is used to retain the longitudinal
positioning of the block 18 relative to the housing 210 and to
thereby maintain the fingers 214 in a selected deployment position.
To deploy, and otherwise alter the lateral spacing of the fingers,
the user disengages the ratchet and slides the block 18 proximally
or distally to move the fingers from a first position to a second
position. Re-engaging the ratchet causes the ratchet to engage the
fingers in the second position. A spring (not shown) biases the
ratchet in the engaged position. Other features relating to
deployment and ratcheting are disclosed in US Publication No. US
2011-0230723.
The system 2 may include features that allow it to sense changes in
the position of the deployment mechanism as an indicator of the
finger's positions relative to the longitudinal axis of the
insertion tube 212.
As shown in FIG. 2B, pulleys 20 are rotatably mounted on the
housing 210. Each pulley 20 is coupled by a link arm 22 to the
block 18, such that longitudinal movement of the block 18 to deploy
the fingers 214 causes the pulleys 20 to rotate. At least one of
the pulleys 20 includes a magnet 24 on its shaft, as shown in FIG.
2C, in which magnets 24 are shown positioned on the shafts of each
pulley 20. The magnet 24 includes diametrically positioned north
and south poles and preferably faces downwardly towards the base
218.
Encoder chips 26 (FIG. 1C) on a distal portion of the base 218
(FIG. 2) are positioned to align with the magnets 24 when the
finger drive assembly 200 is mounted on the base 218. When the
deployment mechanism is utilized, each encoder chips 26 senses the
rotational position of the nearby magnet 24, which indicates the
rotational position of the pulley 20 and thus the longitudinal
position of the block 18. This information allows the system to
know the state of deployment (i.e. the lateral or x-axis position)
of the finger 214. Signals generated by the encoder chips 26 may be
used by the system to coordinate proper transformation between a
user's input instruction and the corresponding output commands.
In alternative embodiments, each finger may be independently
deployed using a separately moveable sliding member 14, so as to
allow each finger to be laterally repositioned independently of the
other finger.
Although the first embodiment uses a manual deployment mechanism,
in a modified system, one or more motors may be used to drive the
deployment mechanism. In some such systems, motor-driven deployment
might be performed independently of the steering of the fingers. In
others, the system might dynamically control both the deployment
mechanism and the finger drivers as a means to move the fingers
into target positions and orientations based on the user's
positioning of the instrument handles at the command unit 250.
Control of the deployment mechanism and the finger drivers at a
given point in time can be based on the calculated current position
and orientation of the fingers using signals from the encoder chips
26 together with other sensed information described below.
Instrument Pathways
Referring to FIG. 1D, the finger assembly's housing 210 has a
generally u- or v-shaped configuration, which each "leg" of the u-
or v-shaped housing the finger drivers associated with a different
one of the steerable fingers 214. While not a requirement, this
shape leaves working space between the "legs" for additional
instruments, as is discussed below.
Ports 222 for the instruments 100 are positioned at the proximal
end of each leg of the u- or v-shaped housing. These ports 222 may
have seals disposed within the housing 210 to prevent loss of
insufflation pressure through the ports 222 when no instruments are
present in the ports and/or to seal around the shafts of
instruments disposed in the ports. Additionally detachable seals
may be placed proximal to the ports 222. One example of this
configuration of seals is illustrated in FIG. 15.
Each port 222 defines the entrance to an instrument path through
the housing 210 and insertion tube 212 into a corresponding one of
the steerable fingers 214. The instrument path includes a tube or
series of tubes extending from the port 222, through housing 210
and insertion tube 212, and out the distal end of the insertion
tube 212 to form the finger 214. The instrument path 221 has a
proximal tube 221a that extends distally from the port 222, and a
distal tube 221b whose proximal end is positioned over the proximal
tube 221a and whose distal end extends through the housing 210 and
insertion tube 212. Central lumen in the proximal and distal tubes
221a, 221b are continuous to form the instrument path 221. The
actuation elements or cables 223 used to steer the finger 214
extend through lumen in the distal tube 221b as shown.
Passive ports 220 (two are shown) are positioned to allow passage
of additional instruments through the housing 210 and the insertion
tube 212. In the drawings, these additional ports 220 are shown
positioned in the crotch of the u- or v-shaped housing 210. These
ports allow instruments such as scopes, rigid instruments and other
instruments to be passed through the insertion tube and used
simultaneously with the instruments deployed through the steerable
fingers 214. Seals (not shown) in these ports 220 are positioned to
prevent loss of insufflation pressure through the ports when no
instruments are present in the ports, and also to seal around the
shafts of instruments disposed in the ports 220.
Finger
Referring again to FIG. 1, each finger 214 includes a deflectable
distal portion 216, which may be formed of a plurality of vertebrae
or links as shown, or flexible tubing, slotted or laser-cut metal
tubing, or other materials capable of being steered without kinking
or buckling. Examples of steerable channels that may be suitable
for use as steerable finger 214 are shown and described in US
2011/0251599 and the other applications referenced herein. A
flexible sleeve/liner (not shown) covers the deflectable distal
portion 216 to avoid capture of tissue in gaps between vertebrae or
slots.
The distal end of each the finger 214 may be equipped with a
telescoping reinforcement feature positioned on its distal end such
that as an instrument tip exits the distal end of the finger, the
reinforcement expands distally in a longitudinal
direction--surrounding the portion of the instrument tip that
extends beyond the end of the finger 214. This feature helps
support any portion of the instrument shaft that extends beyond the
distal end of the finger 214, thus avoiding undesirable flexing of
the instrument shaft within the body cavity.
The fingers 214 are steered through selective pulling and/or
pushing of the actuation elements 223 (e.g. wires, cables, rods,
etc). In this description the term "cable" will be used to
represent any such type of actuation element. The cables 223 are
anchored at the distal end portions of the steerable fingers 214
and extend proximally through the steerable fingers 214 into the
housing 210. The number of cables to be used in a steerable finger
may vary. For example, each steerable finger may include two or
four cables, wherein distal portions of the cables are arranged 180
or 90 degrees apart, respectively, at the distal end of the finger.
In other embodiments, three cables may be used for each finger.
In the illustrated embodiment four cables are used. By "four"
actuation cables it is meant that there may be four separate
cables/wires etc or two cables/wires each of which has a U-turn
anchored at the distal end of the finger such that four cable
proximal ends are disposed within the housing 210. Additional
cables that are not used for actuation may be positioned through
the fingers and used to provide feedback as to the position of the
tips of the corresponding fingers, using methods to those similar
to those described below.
Finger Driver
This section describes the finger driver for one of finger 214
shown in FIG. 1A. It should be understood that the steerable finger
shown on the right side is manipulated using a finger driver having
similar features.
The proximal end of each cable 223 extends out of the proximal end
of the tube 221b and is engaged to a pulley 232a or 232b. Each
pulley 232a, 232b includes a spur gear 231a, 231b as shown. While
the drawings show the axes of rotation of the 232a, 232b pulleys to
be non-parallel relative to one another, in other embodiments the
pulleys may be oriented to have parallel axes of rotation.
A first pair of the pulleys 232a is engaged to two cables 223 that
are anchored at points separated by 180 degrees at the distal end
of the corresponding steerable finger. The components in the finger
drivers are arranged so that each steering motor in the base unit
drives one such pair of the cables--although in other embodiments
each cable has a dedicated steering motor. To allow each steering
motor to drive two cables, each finger driver 203 is arranged with
a first gear 230a disposed between and engaged with the teeth of
the gears 231a on the first pair of pulleys 232a, such that
rotation of the gear 230a in a first direction (by action of a
steering motor as is discussed below) tensions one cable in the
pair and reduces tension on the other cable in the pair, thus
deflecting the distal end of the corresponding steerable finger in
a first direction. Similarly, rotation of the gear 230a in the
opposite direction (by reversing operation of the corresponding
steering motor) deflects the distal end of the steerable finger 214
(not shown) in the opposite direction by tensioning the opposite
cable. A second pair of the pulleys 232b is similarly driven by a
second gear 230b disposed between and engaged with the teeth on the
gears of the second pulleys 232b. The cables associated with the
second gear 230b are also preferably arranged 180 degrees apart at
the distal end of the steerable finger (and offset 90 degrees from
the cables associated with the first gear 230a) allowing for 360
degrees of deflection of the steerable finger 214.
The pulleys 232a, b and gears 230 a, b are housed within a sealed
pulley box 219. The proximal end of the tube 221b and the full
length of the tube 221a (FIG. 4) are housed within the sealed box
219. Each pulley box is mounted within the housing 210 of the
finger drive assembly 200 and oriented with the port 222 exposed at
the proximal end of the housing 210 and with the tube 221b
extending into the insertion tube 212. Seals surround the port 222
and tube 221b to seal the pulley box against passage of moisture
and contamination into the space surrounding the gears and pulleys
during cleaning.
FIGS. 5A-5C show one embodiment of a pulley 232a. Each such pulley
includes a spool 225 rotationally fixed to a shaft 227. Gear 231a
is positioned on the shaft 227 and can spin relative to the shaft
227. The pulley 232a is sprung by a coil spring 229 disposed around
the shaft, with one end of the spring 229 attached to the gear 231a
and the other end attached to the spool 225. The spool includes a
pair of posts 235 spaced 180 degrees apart. The gear has a pair of
stops 237 spaced 180 degrees apart and separated by an annular
space 241. The posts 235 of the spool 225 extend into the annular
space 241.
The cable 223 is wound on the spool 225. Each pair of the cables is
tensioned such that when a finger is in a straight orientation as
schematically shown in FIG. 6A, each post 235 is positioned against
one of the stops 237. When a motor is used to drive the pulleys to
bend the finger to the left as shown in FIG. 6B, the gear 231a of
the pulley 232a on the left spins in a clockwise direction, and as
it spins its stops 237 remain in contact with the posts 235 of the
corresponding spool--thus the gear and spool move as a solid body.
Rotation of the spool tensions the cable 223L, causing the finger
to bend to the left as schematically shown. At the same time, the
gear of the pulley 232a on the right spins in a counter-clockwise
direction and the cable 223R slackens due to compliant members of
the cable transmission and body. As the gear spins, its stops 237
rotate away from the posts 235 of the corresponding gear. Because
the gear 231a and spool 225 are connected by the spring 229 (FIG.
5C), the spring force eventually acts on the spool to rotate it
counter-clockwise, thus taking up extra slack in the cable
223R.
Output from sensors associated with the pulleys is used to
calculate the position of the tips of the fingers, force on the
cable or finger tip by extension, and to provide redundant sensing
of the position of the finger tip relative to that sensed by the
motor's encoder. The following discussion of the use of the sensors
will focus on the situation in which a finger is pulled to the left
as in FIG. 6B, but it should be understand that the same principles
apply for each direction in which the finger is steered.
In general, the system makes use of the passive cable in each cable
pair (a cable pair being a pair of cables tensioned by a common one
of the gears 230a, 230b) to provide positional feedback
corresponding to the position of the tip of the corresponding
finger. Referring to FIGS. 4B and 5A, each pulley 232a, 232b has
disk magnet 243 having a distally-facing surface having
diametrically positioned north and south poles. Encoder chips 245
in the base unit 218 (FIG. 8A, discussed below) are positioned to
detect the rotational position of each such magnet. When the finger
is steered to a bent position, such as the left-ward bend in FIG.
6A, the cable 223L tensioned to produce the bend undergoes elastic
stretching under load, and also deforms the shaft of the tubular
passage 221 through which the cable extends. Thus the distance that
cable 223L was withdrawn to cause the bend does not correspond
directly to the amount by which cable 223R has advanced in response
to bending. Since the passive cable 223R is not under the high
loads being experienced by the active cable, the distance that the
passive cable 223R advanced (as indicated by the degree of rotation
of the magnet 243 sensed by the encoder chip), reflects the amount
by which the finger is bent and can be used by the system to derive
a more accurate measurement of the position of the finger in three
dimensional space. This system is beneficial in that it eliminates
the need for a cable, pulley and sensor arrangement devoted solely
position sensing.
Moreover, the difference between the amount by which the active
cable 223L was withdrawn and the passive cable 223R advanced
represents the amount of force applied by the active cable 223L at
the instrument tip. While feedback as to the force at the tip also
comes from measuring current on the steering motors, the force at
the tip provides a more direct measure of the force.
Feedback from the motor's encoder can be compared with the
positional information obtained from the magnet associated with
cable 223L and used to detect whether there is an error in the
system. For example, if the position measured at the motor is
significantly different from the position derived from the
positions of the magnets 243, the system might alert the user to
the possibility that the active cable 223L is broken and disable
the system 2.
If the pulley associated with an active cable is determined to have
rotated out of its normal range of motion to its extreme relaxed
position (e.g. to a position against the stop 237 opposite to the
stop it should be positioned against in order to be driven by the
gear), it will indicate an error in the system that might
potentially be an error in the system. Feedback indicating that
both pulleys in a pulley pair are in a relaxed state, or have both
rotated to a position against a stop when one of the cables is
tensioned, is indicative of a broken cable. When error conditions
are detected the system, the system may disengage the motors and
deliver an error message to the user via the computer interface
201.
Motion Transfer--Base Unit to Finger Drivers
The finger driver 203 receives motion from the steering motors
236a, b in the base unit 218 through rotational coupling between
elements on the finger drive assembly and elements on the base 218.
On the finger drive assembly 200, members such as driven shafts
226a, 226b (FIG. 7A) are exposed on the bottom of the housing 210.
Each of the driven shafts 226a, 226b is rotationally fixed to and
axially aligned with the one of the gears 230a, 230b (FIGS. 4A and
4B) within the housing 210, such that rotating each driven shaft
226a, 226b rotates the corresponding gear 230a, 230b, thus steering
the steerable finger 214 as described above. The driven shafts
226a, 226b may extend from or be recessed at the lower surface of
the housing 210.
As shown in FIG. 7B, second members such as drive shafts 228a, 228b
are exposed at the upper surface of the base 218 and may extend
from or be recessed at the upper surface of the base 218. Each
drive shaft 228a, 228b is releasably engageable with a
corresponding one of the driven shafts 226a, 226b on the bottom of
the housing 210 (FIG. 7A). Driven shafts 226a, 226b (FIG. 7A) and
drive shafts 228a, 228b (FIG. 7B) are designed for mating
engagement or any alternative form of engagement that will allow
for the transmission of torque from each drive shaft to its
corresponding driven shaft. In the arrangement shown in the
drawings, driven shafts 226a, 226b are male components that mate
with drive shafts 228a, 228b as their female counterparts. The
illustrated male components include hex ball heads of spherical hex
keys and the female components include hex sockets for receiving
the hex heads. In this embodiment the rotational axis of each first
member 226a, 226b angularly intersects the rotational axis of the
corresponding drive shaft 228a, 228b. In other embodiments, however
each first member might share a common rotational axis with the
corresponding drive shaft.
While the driven shafts and drive shafts are shown as hex mating
pieces, any alternative engagement features that will likewise
allow transmission of torque from the drive shafts 228a, 228b to
the driven shafts 226a, and 226b can instead be used.
To facilitate engagement between the drive shafts 228a, b and the
driven shafts 236a,b, the drive shafts 228a,b are downwardly
displaceable into the base unit 218 when first contacted by the
driven shafts 226a,b. Springs bias the drive shafts 228a, b in
their outermost position, so that they will spring upwardly once
mating features of the drive shafts 228a, 228b and driven shafts
226a, 226b engage. Sensors may be positioned in the base unit 218
to sense when each shaft has returned to its fully extended
position, allowing the system to know whether any of the drive
shafts 228a has not properly engaged with the corresponding driven
shaft 226a. This sensed information may be used to lock out use of
the system until all shafts are properly engaged. It can also be
used to initiate minor rotation of the steering motors associated
with the shafts 228a that have not sprung upwardly, to allow the
hex head of the shaft 228a to move to an orientation where it will
engage with the hex socket of the corresponding shaft 226a.
As will be evident from the following section, engaging the driven
shafts and drive shafts allows for the transfer of motion from the
system's steering motors to the pulleys that manipulate the cables
for steering the fingers.
Base Unit
The base unit 218 houses steering motors 236a, b and a roll motor
238. The illustrated system has a u- or v-shaped configuration
similar to that of the housing 210. The base unit 218 is organized
such that motors associated with steering the left-side finger 214
and with axially rolling an instrument extending through the
left-side finger 214 are in the left side of the base unit 218
(e.g. in the left leg of the v- or u-shaped housing), and such
motors associated with the right-side finger and its instrument are
in the right side of the base unit. The computer controllers, motor
drivers, and associated electronics for each side of the system are
also housed within the base unit 218. In this embodiment, two
computer controllers/real time processors are included in the base
unit 210, each associated with one of the fingers, although in
other embodiments a single real time processor may be associated
with both fingers. Communication between these computers and the
user interface computer (e.g. touch screen computer 201 of FIG. 1A)
may use an ethernet TCP/IP connection through a router, or other
means. In other embodiments, a touchscreen processor and real time
processor are housed within a single computer, eliminating the need
for the router.
FIG. 8A shows an arrangement of the motors 236a, b, 238 and their
corresponding gear assemblies within the base unit's housing (not
shown). Each steering motor 236a, b housed within the base 218
drives the gears of its corresponding gear assembly 240a, b.
A gear in each gear assembly 240a, 240b is rotationally fixed to
one of the exposed drive shafts 228a, 228b so that activation of
the motors 236a,b produces axial rotation of each of the drive
shafts 228a, 228b. Two such steering motors 236a, b, are shown for
each finger, each with a corresponding gear assembly 240a, b. Motor
236a is positioned to drive gear assembly 240a to produce axial
rotation of drive shaft 228a. Motor 236b drives gear assembly 240b
to produce axial rotation of drive shaft 228b.
Referring again to FIG. 8A, the output of roll motor 238 in the
base unit is coupled by way of gear assembly 242 to a member such
as a roll driving shaft 244, so as to cause axial rotation of the
roll member 244 when the roll motor 238 is operated. The roll
driving shaft 244 may be similar in configuration to the drive
shafts 228a, 228b.
Roll Driver
The roll driver 216 (FIGS. 1A, 1B and 9) includes a housing 217. As
shown in FIG. 10, a roll drive tube 248 is axially rotatable within
the roll driver housing 217 (not shown in FIG. 10). Roll drive tube
248 includes a lumen for receiving a portion of the shaft of
instrument 100 (FIG. 1A). The exterior of the roll drive tube 248
forms a worm gear, which engages with a roll gear assembly that
includes an adjacent worm gear 249. The roll gear assembly includes
a member such as driven roll shaft 234 that is exposed at the lower
surface of the housing 217 (not shown). The driven roll shaft 234
is axially rotatable relative to the roll driver housing 217.
The roll driver 216 is positionable on the base unit 218 such that
the driven roll shaft 234 rotationally engages with the roll
driving shaft 244 (FIG. 7B) of the base unit 218. This rotational
engagement allows transfer of torque from the shaft 244 to the
shaft 234--thus allowing rotation of the roll drive tube 248 (and
thus the instrument shaft) through activation of the roll motor
238. The shafts 234, 244 may be mating pieces similar to those
described for the driven shafts and drive shafts 226a, b and 228a,
b used for steering.
The roll drive tube 248 has features designed to rotationally
engage with corresponding features on the surgical instrument
shaft. This engagement allows axial rotation of the roll drive tube
248 to produce axial rotation of the distal portion of the
instrument shaft. Preferred features are those that create
rotational engagement between the instrument shaft and the roll
drive tube 248, but not sliding or longitudinal engagement. In
other words, the features are engaged such that axial rotation of
the roll drive tube 248 axially rotates the instrument shaft, but
allow the instrument to be advanced and retracted through the roll
drive tube 248 for "z-axis" movement of the instrument tip.
Rotational engagement between the instrument shaft and the roll
drive tube 248 should preferably be maintained throughout the
useful range of z-axis movement of the instrument tip (e.g. between
a first position in which the instrument tip is at the distal end
of the finger to a second position in which the instrument tip is
distal to the distal end of the finger by a predetermined
distance.)
Engagement features for the instrument 100 and roll drive tube 248
include first surface elements on a drive segment 260 of the shaft
102 of the instrument 100 (FIG. 11) and corresponding second
surface elements on the inner surface of the roll drive tube 248
(FIG. 10). Examples of surface elements 256, 258 are shown in FIGS.
12A-14. Referring to FIGS. 12A and 12B, the drive segment 260 of
the instrument shaft 102 includes first surface elements 256 in the
form of splines or ribs extending radially from the instrument
shaft and longitudinally along the shaft. The lumen of the roll
drive tube 248 includes second surface elements 258 in the form of
longitudinally extending ribs (also visible in FIG. 12B). The
surface elements 256, 258 are positioned such that when the roll
drive tube 248 is rotated, second surface elements 258 on the
interior lumen of the roll shaft contact and cannot rotationally
bypass the surface elements on the instrument shaft. The distal
ends of the splines 256 may be tapered such that they are narrower
(in a circumferential direction) at their distal ends than they are
further proximally, to facilitate insertion of the splines/ribs
between corresponding ones of the ribs while minimizing play
between the splines 256 and adjacent ribs 258 as the roll shaft
rotates the instrument shaft. The longitudinal length of the
splines 256 is selected to maintain rotational engagement between
the instrument shaft and the roll shaft throughout the desired
z-axis range of motion.
The drive segment 260 of the instrument shaft may have a larger
diameter than proximally- and distally-adjacent sections, as shown
in FIG. 11. To facilitate insertion of the drive segment 260 into
the roll drive tube 248, the drive segment 260 includes a chamfered
distal edge 262.
As another example, shown in FIGS. 13A-13C, the drive segment 260
has a hexagonal cross-section and the roll drive tube 248 has
longitudinal grooves with v-shaped radial cross-sections as shown.
Edges 256a of the drive segment 260 formed by corner regions of the
hexagonal cross section seat in troughs 258a so as to permit
longitudinal sliding of the instrument through the lumen but
prevent rotation of the instrument within the lumen.
In another embodiment shown in FIG. 14, drive segment 260 includes
longitudinally extending grooves 256b. One or more pins 258b extend
radially inwardly from the luminal wall of the roll drive tube 248
and into engagement with one of the grooves 256b.
It should be noted that the instrument 100 is preferably
constructed so that the roll drive tube 248 will cause rolling of
the drive segment 260 and all portions of the instrument shaft 102
that are distal to it (including the end effector), without causing
axial rolling of the instrument handle 104. Thus the handle and
shaft are coupled together in a manner that permits the instrument
shaft to freely rotate relative to the handle when acted upon by
the roll drive tube 248. For example, the instrument 100 might
includes a roll joint within, or proximal to, the drive
segment.
Tubular Connectors
Openings 264 and 266 (FIG. 1C) at the proximal and distal surfaces
of the roll driver housing 217 allow passage of an instrument shaft
through the lumen of the roll drive tube 248. If, as in the first
embodiment, the finger drive assembly and the roll drivers are
separate components, any gap between the components is bridged by a
tubular connector 268 mounted between the distal opening 266 of the
roll driver housing 217 and the proximal port 222 of the housing
210 so as to provide a continuous instrument path. The tubular
connector 268 can be removably connected to the roll driver housing
217 and the housing 210, or it might be more permanently connected
to one or both of them. There may also be a similar tubular
connector between the instrument box 252 and opening 264 on the
roll driver to guide the instrument shaft into the roll driver.
Referring to FIG. 15, the tubular connector 268 may include a luer
port 274 for use as a flush port or for directing insufflation gas
through the finger drive assembly 200 and into the body cavity. A
valve 270 such as a cross-slit valve is positioned within the
tubular connector 268 to prevent loss of insufflation pressure
through its proximal end, when no instrument is present. A second
seal 272 is positioned to seal against the shaft on an instrument
that passes through the tubular connector, thus minimizing loss of
pressure around the shafts of an instrument disposed through the
connector 268. In other embodiments, the luer port 274, valve 270,
and seal 272 may be disposed in the housing 210. A single seal, or
other seal configurations may also be utilized to seal with and
without an instrument present.
Command Interface
Referring again to FIG. 1A, the base unit includes a command
interface 250 equipped to generate signals corresponding to the
position of, and/or a change in the position of, a proximal part of
the surgical instrument 100 when the handle 104 is manually moved
by a user (as well as other signals discussed below). The system
generates control signals in response to the signals generated at
the command interface. Such control signals are used to drive the
motors 236a, b, 238 to steer the fingers and roll the instrument's
shaft in accordance with the user's manipulation of the instrument
handle. Thus, manual movement of the instrument handle by the user
results in motor driven steering of the instrument's distal end and
motor driven axial roll of the instrument shaft.
In this embodiment, it is the instrument's handle 104 (FIG. 1)
whose movement triggers the signals of the command interface that
result in steering of the fingers and rolling of the instruments.
In other embodiments, a proximal portion of the instrument shaft,
or another component of the instrument can be used. Still other
embodiments use a separate user input device to generate the
signals inputting the desired position of the instrument, rather
than user input devices that respond to the user's movement of the
instrument handle itself.
Turning to FIG. 16, the command interface 250 includes a first
portion or bracket 276a that is anchored to the base 218 (not
shown) and rotatable about an axis A1 (which may be generally
normal to the surface of the base). A second portion or bracket
276b is mounted to the first bracket 276a and is rotatable about
axis A2 (which may be generally parallel to the surface of the base
and perpendicular to A1).
The instrument box 252 is positioned on the second bracket 276b as
shown in FIG. 1. Referring again to FIG. 1A, the instrument box
includes a housing 253a removably attached to the second bracket
276b, so that the instrument box may be detached after surgery for
disposal or sterilization and reuse. A passage 275 for the surgical
instrument 100 extends through the housing as shown. As shown in
FIG. 16, in the first embodiment, an opening 253b in the housing
253a is slidable over the proximal portion of the second bracket
276b. A spring latch 255 (FIG. 1A) between the instrument box 252
and bracket 276b engages the two components once the instrument box
252 has been advanced to the proper position.
The instrument box 252 is configured to receive the surgical
instrument 100 and to allow the instrument shaft to slide relative
to the instrument box 252 during z-axis positioning of the
instrument. The arrangement of the first and second brackets 276a,
276b with the instrument box 252 (and therefore the instrument 100)
renders the interface 250 moveable about the axes A1, A2 when the
user moves the instrument handle. Up-down movement of the
instrument handle results in pitch movement of bracket 276b about
axis A2, and side-side movement of the instrument handle results of
yaw movement of bracket 276a about axis A1, with combined up-down
and side-side movement resulting in combined pitch and yaw
motion.
Encoders within the command interface 250 generate signals in
response to movement about the axes A1, A2. In particular, a first
encoder is positioned such that it will generate signals
corresponding to yaw movement of first bracket 276a (about axis
A1). A second encoder is positioned to generate such signals
corresponding to pitch movement of second bracket 276b (about axis
A2). Types of suitable encoders include optical or magnetic
incremental rotary encoders that generate signals corresponding to
the speed and the incremental amount of angular movement are
suitable for this purpose. Signals generated by these encoders are
received by electronics housed within the base unit 218 and used to
control and drive the steering motors 236a, b (FIG. 7B).
The instrument box houses components that cause several types of
user input signals to be generated by the system in response to
user action, including: (a) signals representing the amount by
which the user axially rotates the instrument handle or an
associated roll knob; (b) signals indicating proper placement of an
instrument 100 into engagement with the system at the instrument
box; (c) signals from a user-operable engage/disengage button that
lets a user selectively engage or disengage operation of the
command interface 250 from activation of the motors; and (d)
signals generated in response to z-axis movement of the instrument
to indicate the z-axis position of the instrument 100.
Referring to FIG. 17A, the instrument box 252 includes an elongate
tube 278 having a knob 254 on its proximal end. A lubricious inner
tube 279 extends through the elongate tube 278 and has a proximal
block 282 surrounded by the knob 254. The block 282 supports one or
more exposed metallic elements, such as the proximally-facing
metallic elements 284. A magnetic sensor 286 is within the block
282. An opening in the block 282 is positioned to receive the shaft
of an instrument 100 so that instrument shaft can pass tube 278. A
spring loaded pin 281 extends into the opening in the block
282.
In FIG. 17A, the handle of instrument 100 is shown only partially
advanced towards the knob 254 to allow certain features to be
visible. A collar 106 is located on a proximal portion 108 of the
instrument's shaft. The distal side of the collar 106 is most
easily seen in FIG. 11B. It includes a distal part having a notch
109. A magnet 110 in the collar 106 faces distally. These features
are located such that when a user advances the instrument 100
through the opening in the block 282 with the notch 109 facing the
pin 281, the notch 109 captures the pin 281 to rotationally engage
the instrument handle to the block 282. The magnet 110 magnetically
adheres to the metallic elements 284 when brought into proximity to
them, thus retaining the instrument in position against the block
282.
The sensor 286, which may be a Hall sensor, is positioned so that
it will generate an instrument presence signal when the magnet 110
is positioned at the metallic elements 284. This signal alerts the
system that an instrument is properly positioned at the command
interface 250 and the system is therefore ready to control the
steerable fingers and the instrument roll position when the user is
ready to do so.
The system may therefore be configured such that the motors used to
steer a given finger will not be activated in the absence of an
instrument presence signal from the sensor 286, unless the user
otherwise overrides this feature. This feature prevents inadvertent
movement of a finger when there is no instrument extending through
it.
A user actuated switch is positioned to generate a signal
indicating whether the user wishes to place the system in an
"engaged" state. The switch may be located near the users hand for
easy access, such as on the instrument box 252, the instrument, or
elsewhere on the system 2. Alternatively, the switch may be a foot
pedal or voice activated circuit.
In the first embodiment, the switch is actuated using a button 288
positioned adjacent to the knob 254 and supported by a button
assembly (not shown). A magnet (not shown) is carried by the button
assembly. When the engage button 288 is pressed, the button
assembly moves the magnet into or out of alignment with a Hall
sensor, causing the Hall sensor to generate a signal that the
button has been pressed. When pressure on the button 288 is
released, a spring (not shown) returns the button to its original
position. Feedback is provided to the user when the system is moved
in and out of the engaged state. For example, an LED 245 on the
instrument box can turn on, or change color, when that part of the
system is engaged and turn off when it is disengaged. An auditory
tone might additionally be sounded when the system is moved between
the engaged and not-engaged state. An electrical connector 99 (FIG.
17B) in connected between the instrument box and the bracket 276b
to apply a voltage to the LED.
When the engage button has been pressed, the system moves from a
"not engaged" state to an "engaged" state with respect to the
instrument on that side of the system. When in the engaged state
(assuming instrument presence has been detected as discussed
above), the system will activate the motors in response to detected
movement at the command interface 250. Pressing that same engage
button 288 again will generate another signal used by the system to
move the system to a "not engaged" state with respect to the
instrument on that side of the system. When the system is in the
"not engaged" state, the steering and roll motors will not be
activated and the orientation of the fingers 214 and the roll drive
tube 248 remain fixed. The instrument presence sensor 286 and the
user actuated engage button 288 are therefore useful safety and
convenience features designed to prevent activation of the steering
and roll motors 236a,b, 238 even in the presence of detected
movement at the command interface 250. This is beneficial in a
variety of circumstances, such as when the user wishes to remove
his/her hand from the instrument handle without causing inadvertent
movement of the fingers within the body as the command interface
250 shifts position or is inadvertently bumped. The user might also
wish to disengage the system in order to maintain the orientation
of a finger 214 within the body cavity while s/he re-positions the
command interface to a more ergonomic position, or while s/he
replaces the instrument extending through that finger with another
instrument s/he wants to deliver to the same location within the
body.
If the user elects to change the position of the button 288
relative to the instrument handle 104, s/he may do so by rotating
instrument collar 106 relative to rotation knob 254.
A cord (not shown) extending between the block 282, knob 254 or
adjacent structures may be used to carry signals from the
instrument presence sensor 286 and the sensor associated with the
user actuated button 288 to circuitry in the base or command
interface 250.
Roll Input
The instrument box 252 gives the user two ways in which to trigger
motorized rolling of the instrument's shaft. The first way is to
spin the knob 254; the second way is to rotate the instrument
handle 104. In the first embodiment, the rotation knob 254 is
positioned near the instrument handle 104, allowing the user to
find the knob in a position similar to the position of a rotation
knob on a standard hand instrument.
Supports 290, 292 are mounted in fixed positions within the
instrument box 252. A first gear 294 is rotationally engaged with
the exterior surface of the tube 278, and a second gear 296 is
adjacent to and engaged with first gear 294. Knob 254, tube 278,
and thus gear 294 are axially rotatable relative to instrument box
252, and their rotation produces corresponding rotation of the
second gear 296. Rotation of the second gear 296 produces rotation
of a magnet positioned such that rotational position of the magnet
is sensed by an encoder in the command interface 250. There may be
a sterile drape present between the magnet and encoder. Referring
to FIG. 17B, the magnet is a disk magnet 300 supported on a post
298. The post 298 extends distally from the second gear 296 and
rotates when the gear rotates. The magnet 300 includes a
distally-facing surface having diametrically positioned north and
south poles.
When the instrument box 252 is mounted on the bracket 276b, the
post 298 extends into a corresponding opening 302 (FIG. 16) in the
bracket 276b. An encoder chip 304 is positioned within the opening
302 so as to sense the rotational position of the magnet 300 on the
post 298 (which indicates the rotational position of the knob 254).
Signals generated by the encoder chip 304 are used to generate
drive signals for the roll motor in response to rotation of the
knob 254. Roll input is similarly generated through rolling of the
instrument's handle. Because the instrument's collar 106 is
rotationally coupled to the tube 278 (via block 282), rotating the
instrument handle rotates the tube 278, and results in the
generation of a signal at the encoder chip 204 as described
above.
In an alternative embodiment, a rotatable knob on the instrument's
handle may be rotatable to generate the roll input signals in a
similar manner.
Because there is friction at the instruments roll joint 260 (FIG.
11A) between the distal portion 102 of the instrument shaft and the
proximal portion 108 of the instrument shaft, rolling of the distal
portion can result in a slight roll of the proximal portion 108
which can generate roll input by the roll encoder chip 204.
Referring to FIG. 17A, the instrument box 252 is designed to apply
friction against rotational movement of the gear 296 using an
element positioned between the instrument box 252 housing (or
another fixed support within the instrument box) and the gear 296
or post 298. A friction plate 247 has a first face in contact with
the proximal end of the gear 296 or post 298, and a second face in
contact with the interior of the instrument box 252 (not shown in
FIG. 17A). The friction plate 247 imparts frictional resistance
against rotation of the gear 296. The amount of friction is
selected such that it is more than the friction present between the
distal shaft 102 and the proximal shaft 108 at the instrument roll
joint 260. Rotation of the proximal portion of the instrument shaft
108 resulting from friction at the roll joint 260 is thereby
prevented from becoming input to the roll encoder chip 204, thus
preventing forward feedback.
Z-Axis Movement
Z-axis movement of the instrument to move the instrument tip
proximally or distally within the body cavity is manually performed
by pushing/pulling the instrument handle 104. The instrument box
250 is configured so that the knob 254 and instrument handle 104
can be used to generate instrument roll input regardless of the
z-axis position of the instrument handle relative to the instrument
box 252. When the instrument's collar 106 is coupled with the block
282, z-axis movement of the instrument (i.e. advancement and
retraction of the instrument between distal and proximal positions)
causes the knob 254 and tube 278 to likewise move along the
z-axis--keeping the instrument and the roll input features engaged
throughout z-axis travel. A constant force spring 320 (FIG. 17B) is
connected between a collar 280 on a distal portion of the tube 278
and the support 290. When the instrument is advanced in a distal
direction, the tube 278 pushes the collar 280 distally, against the
force of the spring 320. When the user removes the instrument
handle 104 from the instrument box 252, the spring 320 retracts the
tube 278 and thus the collar 280 returns to the proximal position.
When an instrument is present the spring 320 force would be less
than the frictional force required to move the instrument, and the
instrument would maintain position with no user input.
The instrument box may include a lock to prevent the tube 278 from
advancing distally during insertion of an instrument into the tube
278. The lock may be a mechanical latch manually releasable by the
user or electronically released in response to a signal produced by
the instrument presence sensor.
The features of the instrument box allowing the z-axis position of
the instrument to be determined will next be described with
continued reference to FIG. 17B. A pin 308 extends laterally from
the collar 280. A lever arm 310 has a first end having a slot 312
slidable over the pin 308. A second end of the lever arm 310 is
pivotably coupled to a stationary lever arm mount 314 mounted
within the instrument box. A magnet 316 is positioned at the pivot
axis of the lever arm 310, and rotates as the lever arm 310 pivots.
The magnet 316 includes a distally-facing surface having
diametrically positioned north and south poles.
Referring to FIG. 16, when the instrument box 252 is mounted on the
bracket 276b, the magnet 316 (FIG. 17A) is positioned in alignment
with an encoder chip 318 mounted in the bracket 276b. The encoder
chip 318 generates signals representing the rotational position of
the magnet 316 and thus lever arm 310, from which the axial
position of the tube 278 and thus the instrument 100 can be derived
by the system.
A scaling factor is the amount by movement of the instrument or
finger is scaled upwardly or downwardly relative to the user's
movement of the instrument handle. The system 2 uses the determined
z-axis position of the instrument to dynamically adjust the scaling
factors used in control of the steering motors. For example,
smaller scaling factors might be used for steering when the
instrument is fully extended from the finger than would be used
when the instrument tip is closer to the tip of the finger to give
consistent steering relative to the user input regardless of the
instrument's z-axis position.
The first and second brackets 276a, b of the command interface 250
may be covered by sterile drape for use, while the instrument box
252 remains external to the drape.
Electromechanical Block Diagram
FIG. 18A shows an electromechanical block diagram of the system 2,
as slightly modified for an embodiment in which a roll input wheel
is positioned on the instrument shaft rather than on the instrument
box as discussed above. Certain other features, including the
deployment sensor, are not shown, and in the FIG. 18A embodiment
the roll driver is included as part of the base unit (labeled
"Drive Assembly") rather than as a separate component.
Use
To use the system 2, the base unit 218 and the first and second
portions 276a, 276b of the command interface 250 are covered by a
sterile drape. The housing 210 of the finger drive assembly 200 and
roll driver 216 are mounted to the base unit to engage the motor
driven members 228a, 228b, 244 of the base unit 218 with the driven
members 226a, b, 234. The system monitors engagement between the
shafts 228a, 228b, 244 of the base unit with the shafts 226a,b, 234
of the finger and roll drivers, and shafts 228a, 228b, 244 found to
not have not engaged with their counterparts may be rotated
slightly through motor activation as described in "Motion Transfer"
section above.
The instrument box 252 is mounted to the second portion 276b of the
command interface 250. Spring latches 255 engage to secure the
housing 210 and roll driver 216 to the base unit 218 when the
components are properly aligned. Similar spring latches are engaged
to secure the instrument box 252 to the portion 276b of the command
interface.
Sterile tubular connectors 268 are coupled between the roll driver
216 and the port 222 on the housing 210, and similar connectors may
be positioned between instrument box 252 and the roll driver 216.
Once the system 2 is assembled, the distal end of the finger drive
assembly 200 is positioned within the body cavity of the patient.
Alternately, the finger drive assembly may also be positioned
inside the patient and then assembled to system 2. For easy
insertion into the body cavity, the deployment mechanism is used to
position the fingers 214 in a streamlined side-by-side
configuration using the links 12. The fingers 214 and a portion of
the insertion tube 212 are the passed through the incision into the
body cavity. The distal tip of a medical instrument (e.g. forceps,
graspers or other flexible shaft hand instruments) is inserted
through the instrument box 252 and advanced distally. Advancing the
instrument causes the tip to exit the instrument box 252, pass
through the roll driver 216, then into port 222 on the proximal end
of the finger drive assembly's housing 210, and through the
corresponding finger 214 until the distal end of the instrument
extends from the distal end of the finger 214.
When an instrument is fully inserted through the command interface
250, instrument presence signals are generated at sensor 286 (FIG.
17A).
Additional instruments such as scopes, graspers and the like are
passed through the insertion cannula via ports 220 for use
simultaneously with the instruments deployed through the
fingers.
The deployment mechanism is used to adjust the lateral spacing of
each finger (and thus the instrument passed through it) relative to
the longitudinal axis of the insertion cannula as described with
respect to FIGS. 2A through 2C.
Before the user can steer or roll the instrument using the system,
s/he presses the engagement button 288 to cause the system to enter
into the engaged state.
At least when the system is placed in an engaged state, the system
senses the positions of the brackets 276a,b and the roll input
magnet 300 to determine the starting position of the instrument's
handle 104.
If the system is in an engaged state and the instrument's presence
has been detected, the system will respond to steering and roll
input at the command interface 250 by engaging the steering and
roll motors to steer the finger and roll the instrument. To steer
the instrument 100 within the body, the user manipulates that
instrument's handle 104. For example, to move the instrument's end
effector upwardly, the user will lower the handle; to move the end
to the left, the user will move the handle to the right. (Although
in alternate arrangements, the system may be configured such that
the end effector moves in the same direction as the handle--so
that, for example, raising the handle raises the end effector). The
encoders in the command interface 250 sense the movement or
position of the handle by sensing rotation of the brackets 276a, b
relative to axes A1, A2. In response, the system generates control
signals to activate motors 236a, b to thereby steer the finger and
the instrument that extends through it. To axially roll the
instrument, the user axially rolls the instrument handle 104 or the
rotation knob 254 relative to the instrument box 252, producing
signals at the roll encoder chip 304. In response the roll motor
238 is activated to roll the distal part 102 of the instrument
shaft. To position the instrument further into the body cavity, the
user pushes the instrument handle 104 distally. This z-axis
movement of the instrument is sensed by encoder 318, and the z-axis
position of the instrument may be used by the system to dynamically
adjust scaling factors for finger steering and/or instrument
roll.
FIG. 18B is a schematic of an exemplary drive control sequence for
controlling the steering motors to drive the fingers based on
sensed information (e.g. approximations of the positions of the
fingers, the positions of the user interface etc), using forward
and reverse mapping and PID control.
Actuation of the instrument's end effector, such as the
opening/closing of jaws, is carried out in conventional fashion
using manual actuators (e.g. levers, knobs, triggers, slides, etc.)
on the instrument handle. If desired, an instrument may be
withdrawn from the system during the procedure, and replaced with a
different instrument, which again may be steered and axially
rotated through manipulation of the handle as described.
The first embodiment is but one example of ways in which the
mechanized system may be configured. Various modifications may be
made to that embodiment without departing from the scope of the
invention.
A few such modifications will next be described, but many others
are possible and within the scope of the invention.
While the drawings show the two finger drivers in the housing 210
and each roll driver 216 in a separate housing, other embodiments
use different layouts. For example, the design may be modified to
position the roll drivers 216 in a common housing with the finger
drivers. As a second example, the roll drivers 216 might both be
mounted in a common housing that is separate from the housing 210
containing the finger drivers. In another embodiment, the roll
driver and finger driver associated with the left-instrument may be
a common housing, with a separate housing used for both the roll
driver and finger driver associated with the right-instrument.
Other embodiments might package each of the roll drivers and finger
drivers as four separate components.
In other embodiments, the motors are integrated into the assemblies
of the corresponding finger drivers and the roll drivers rather
than being detachable from them.
Second Embodiment
The system 2A of the second embodiment, shown in FIG. 19, differs
from the first embodiment primarily in that the features of the
roll driver are incorporated into the base. More particularly, a
base 218a includes an elevated portion 216a that houses the roll
drive tube 248 (not shown). An instrument passage extends between a
proximal opening 264a and a distal opening (not shown) in the
elevated portion 216a. The instrument shaft extends through the
passage elevated portion 216a between the command interface 250 and
the finger drive assembly 200. A sterile tubular insert (not shown)
is insertable through the instrument passage in the elevated
portion 216a to prevent the instrument 100 from contaminating the
passage.
Third Embodiment
Referring to FIG. 20, a third embodiment of a surgical access
system 2B includes a body 210a and an insertion cannula 212
extending distally from the body 210a. Fingers 214 extend from the
insertion cannula 212. The finger 214 may have properties similar
to those described elsewhere in this application.
Each finger includes a dedicated deployment mechanism operable to
independently reposition the distal portion of the fingers 214 to
increase or decrease its lateral separation from the longitudinal
axis of the insertion cannula 212. Each deployment mechanism
includes a rigid, longitudinally slidable, member 14a and at least
one link arm 12a (two are shown for each finger). The rigid member
14a may be constructed of a proximal portion comprising a straight,
single-lumen, tube made of stainless steel or rigid polymeric
material, and a distal bar extending from the tubular proximal
portion. The distal bar may be integral with a portion of the wall
of the tubular proximal portion. Each finger 214 extends distally
from the lumen of the tubular proximal portion of the rigid member
14a.
The deployment system works similarly to that described for the
first embodiment. Each link 12a has a first end pivotally coupled
to the rigid member 118 and a second end pivotally coupled to a
corresponding finger 214, proximally of its distal end. In the
illustrated embodiment, these pivotal connections are formed at
collars 122 disposed on the fingers. The rigid member 14a is
longitudinally moveable relative to the insertion cannula 212 to
pivot the links 120 inwardly and outwardly. In the illustrated
configuration, sliding 14a in a distal direction pivots the second
ends of the links 120 outwardly to deploy the corresponding finger
or to further separate the finger from the longitudinal axis of the
insertion cannula 212. Alternate configurations may operate in
reverse, so that retraction of the member 14a increases the
separation of the fingers.
Each finger may further include a support member or strut 124
having a first end pivotally connected to the collar 122 and a
second end pivotally connected to the corresponding one of the
members 14a or to the insertion cannula 212. The support struts 124
support the fingers, helping to maintain the longitudinal
orientation of the fingers, and preventing them from sagging or
buckling during use.
Slide rings 126 are shown for independently sliding each member 14a
longitudinally for finger deployment, allowing the user to
advance/retract the member 14a by advancing/retracting the ring 126
relative to the body 210a. The ring may include a ratchet feature
function as described in the '307 application, which releasably
locks the finger in a chosen longitudinal and lateral position by
releasably engaging the longitudinal position of the member 14a.
FIG. 20 shows that this arrangement allows each finger to be
deployed to have a different amount of lateral separation and
longitudinal extension.
The tips T of instruments 100 are shown extending from the distal
ends of the fingers. The body 210a includes proximal openings 128
for receiving the instruments. To deploy an instrument 100 from a
finger 214, the tip of that instrument is inserted through one of
the proximal openings 128 and advanced through the body 210a,
insertion cannula 212 and finger until its tip T or end effector
extends out of the finger. In the FIG. 20 drawing, the handle 104
for the instrument used through the finger on the left is not
shown, so as to allow the proximal opening 128 to be seen.
A primary difference between the third and first embodiments is
that the features described for inclusion in the first embodiment's
finger drivers, roll drivers, command interface (including the
instrument box) and base unit are incorporated into the housing
210a.
Sensors 130 are positioned on the body 210a to sense pitch and yaw
movement of the instrument handle 104. Motors 236a, b in the body
210a are engaged with cables that extend through the fingers and
that are anchored to the fingers (e.g. at 90 degree intervals) to
deflect the fingers according to the sensed position of the handle.
For example, a first motor 236a may be positioned to drive a first
pair of cables corresponding to yaw motion of the finger distal
end, and a second motor 236b may be positioned to drive a second
pair of cables corresponding to pitch motion of the finger distal
end.
Automation may also be provided for driving axial rotation of an
instrument disposed through a finger. A handle sensor 304 is
positioned to sense axial rotation of the instrument handle 104,
and is operatively associated with a roll motor 238 that will
produce or aid an axial roll of the instrument or a finger using
gear 134.
As with the first embodiment, actuation of the instrument's end
effector, such as the opening/closing of jaws, is carried out in
conventional fashion using actuators (e.g. levers, knobs, triggers,
slides, etc.) on the instrument handle. If desired, an instrument
may be withdrawn from the system during the procedure, and replaced
with a different instrument, which again may be steered and axially
rotated through manipulation of the handle as described.
The system 100 may include a mount 90 engageable with a
stabilization arm such as the arm 204 (FIG. 1B) that can be coupled
to a cart, the surgical table or to another fixture within the
operating room. The stabilization arm may be manually positionable
or adjustable using motor driven joints and telescoping members,
allowing the height and orientation of the system 2B to be adjusted
using a user input such as foot pedals or other input devices.
Fourth Embodiment
The FIG. 21 embodiment is similar to the FIG. 20 embodiment, but
further incorporates a mechanism for Z-axis movement of each finger
214. While use of the slide ring 126 in the FIG. 20 embodiment
produces a z-axis change of the corresponding finger position, the
FIG. 21 arrangement allows for z-axis movement that is independent
of the lateral position of the finger relative to the insertion
cannula 212.
In particular, the system has two body sections 210c, each of which
is longitudinally slidable along a central track 136. Each body
section is coupled to one of the fingers and its corresponding
deployment system (member 14a, links 12a, support strut 124,
deployment ring 126). In one embodiment, the insertion cannula 212
is coupled to the track 136, and each finger and its drive and
deployment systems move longitudinally relative to the cannula in
response to manual pushing/pulling by the user. While the primary
z-axis adjustment is now carried through on a platform with a
linear bearing for each side of the system, the deployment
mechanism remains for the adjustment of the tool separation
(identified as x-axis in the drawings). Note that each side has an
independent deployment system so that the span is independently
controlled for each instrument.
Fifth Embodiment
The FIG. 22 embodiment is similar to the FIG. 21 embodiment, but is
provided in a more modular format. This embodiment includes
independent body sections 210d which house the pitch, yaw and roll
motors 236a, b, 230, the sensors 130, 304, and which include the
opening 128 for receiving the instrument 100. A pair of finger/roll
driver 203a each having pulleys 232, cables (not shown), and a roll
drive tube 248 are provided, with each finger/roll driver 203a
connected to one of the fingers 214. Each finger/roll driver 203a
is releasably engagable with a body section 210d in a manner that
allows the motors in the body section 210d module to actuate the
pulleys 232 in finger/roll driver 203a so as to tension the cables
and roll the finger/roll driver 203a to steer the finger and roll
the instrument. Slide rings 126 for finger separation (x-axis) are
located on the finger/roll drivers 203a.
Sixth Embodiment
In the FIG. 20-22 embodiments, pitch, roll and yaw are sensed and
the finger is electromechanically controlled to position the
instrument, however the jaw clamping action or other end effector
action of the instrument is mechanically driven by a mechanical
actuator on the instrument handle. The FIG. 23 embodiment is
largely similar to the FIG. 22 embodiment, but rather than using a
hand instrument having a mechanical actuator, it uses an alternate
surgical instrument 100a. The instrument 100a engages with a motor
138 in the motor module that is activated to operate the end
effector (e.g. jaw) of the tool. In one embodiment, control of the
finger and roll drivers is responsive to user manipulation of the
instrument 103a to control pitch, roll and yaw as discussed with
respect to prior embodiments, but the system is instrument
configured to receive signals from an input device (e.g. a switch,
foot pedal) to initiate actuation of the end effector via motor
138. In other embodiments, the pitch, roll, yaw and jaw motors may
be operable in response to signals received from a separate user
input device such as a joystick or other forms of input device(s)
rather than manual manipulation of the instrument 103a.
Seventh Embodiment
The FIG. 24 embodiment is similar to the FIG. 23 embodiment, but it
automates the z-axis movement using a motor 140 that
advances/retracts the bodies 210e and the finger/roll driver 203a
along the track 136. Moreover, it eliminates the mechanical
deployment mechanism and instead automates the x-axis or lateral
positioning of the finger using an additional motor 142 in each
body 210e. The motor 142 advances/retracts the element 14a to
expand the links 12a for deployment and x-axis positioning.
Automating the z- and x-axis movement allows for complex volumetric
motions of the instrument beyond what can be achieved using
mechanical z- and x-axis movement. Providing a dynamic z-axis
increases reach of the instrument while introducing a dynamic
x-axis enables complex orientation movements of the instrument
tips. Tip movement in the x-direction can in a sense be de-coupled
from movement in the z-direction, by automatically adjusting the
finger's z-axis position to off-set z-axis changes resulting from
pivoting of the links 12a during x-axis adjustments.
FIG. 25 shows but one example of a user input device that can be
used in systems such as the FIGS. 23 and 24 systems that use input
devices that are separate from the instrument handle and shaft. A
input device 500 shown in FIG. 25 includes a handle to be
manipulated by a user in accordance with the desired position of
the surgical instrument. The input device incorporates at least
four sensors (associated with multiple pivot joints in a control
handle) and an actuator 502 for simulating the grasping load to be
achieved at the instrument's end effector. The input device is
connected to the body 210d, 210e through digital communication
wires and can be located on or near the body 210d, 210e at the
patient's bedside, preferably within the sterile field. For
example, the input device 500 and the body might be positioned on a
common arm (such as arm 204), on different arms supported by a
common cart or other fixture (e.g. the operating table or a ceiling
mount), or on separate arms on the same or different fixtures. The
FIGS. 23 and 24 systems may be provided with various
interchangeable tools 100a, each having a different end effector,
allowing the user to exchange tool modules as needed during the
course of a surgical procedure.
Eighth Embodiment
FIG. 26 shows a system 2E that is similar to the first embodiment.
However, the finger drive assembly 203, roll drivers 216, command
interfaces 250, motor drivers and associated electronics are
integrated into a single component. Two steering motors 236a, b are
shown on each side of the system 2E, one for each pair of cables.
However, each cable may instead have its own dedicated motor.
While certain embodiments have been described above, it should be
understood that these embodiments are presented by way of example,
and not limitation. It will be apparent to persons skilled in the
relevant art that various changes in form and detail may be made
therein without departing from the spirit and scope of the
invention. This is especially true in light of technology and terms
within the relevant art(s) that may be later developed. Moreover,
features of the various disclosed embodiments may be combined in
various ways to produce various additional embodiments.
Any and all patents, patent applications and printed publications
referred to above, including for purposes of priority, are
incorporated herein by reference.
* * * * *